Jerardo Lobato Hernandez waits for his appointment time with his pet dog Candy, outside the Mission Neighborhood Health Center in San Francisco. The center is being credited with saving Hernandez life, after he was diagnosis with AIDS and Hepatitis C. Friday, May 11, 2012.

Jerardo Lobato Hernandez lived on the streets of San Francisco for nearly a decade, struggling with severe depression, alcoholism and AIDS. Police arrested him regularly for public drunkenness, trespassing and illegal camping. Twice thieves put his health at risk when they stole his medications, which he is supposed to take daily.

He's "in great shape now," said Alberto Rangel, Hernandez's medical social worker at the Mission Neighborhood Health Center. Living in a residential hotel, receiving regular medical and psychiatric treatment and attending AA meetings though not yet sober, Hernandez's life has stabilized, his AIDS under control.

He is one of the success stories of San Francisco's nationally recognized model of care for people living with AIDS and HIV and those at highest risk of infection. But the system is under siege, say care providers.

The city is set to lose almost $8 million in federal AIDS funding in the new fiscal year that starts July 1 - the biggest one-time cut ever - and $10 million the following year.

The deep cuts would not shutter any programs, but would jeopardize care for people living in San Francisco with AIDS and HIV, city officials and care providers say.

He and others hope the city will step in to fund the money lost from the Ryan White Care Act and the Centers for Disease Control. The Ryan White Care Act funding provides health care and social services for uninsured, underinsured and other financially vulnerable people living with HIV and AIDS. Funding allocated by the CDC is for prevention programs. Combined, the city got $41.8 million from the two federal programs for the current fiscal year that ends June 30.

A support system

For the poor and marginalized, it doesn't take much to destabilize their health if they lose their housing, fail to take their medications, or miss out on treatment for substance abuse and mental health problems. "It's very easy for the downward spiral to begin," Smith said.

His nonprofit, the AIDS Emergency Fund, provides grants of about $500 each to some 2,400 clients a year, helping them cover such expenses as rent, utilities, prescriptions and medical treatment. Nearly half the annual $2.1 million budget is Ryan White funding.

About 40 programs run by the city and nonprofits in San Francisco that serve thousands of clients rely, in part, on Ryan White grants. The money is used for services that include legal counsel, food delivery to the homebound, dental and medical care, mental health and substance abuse counseling, housing assistance and hospice care.

Many people, like Hernandez, rely on a web of services to keep them alive.

"I'm doing much better now," said Hernandez, 51.

Asking for city help

Federal AIDS funding no longer favors urban areas like San Francisco because most new infections occur in suburban areas. With the cuts looming, three supervisors from the LGBT community, Scott Wiener, David Campos and Christina Olague, have made funding restoration a priority, and service providers have stepped up their lobbying efforts to get Mayor Ed Lee to include restoration funding in his budget proposal, due out June 1.

In January, the mayor authorized a $1.8 million budget supplemental to offset earlier cuts in Ryan White Care Act funding that threatened HIV and AIDS programs in the current fiscal year that ends June 30. Now Lee is being asked to allocate more local funds to make up for the lost federal funds in the new budget cycle.

"The cuts would be devastating," said Wiener, who represents the Castro district, which has been the epicenter of the HIV/AIDS epidemic in San Francisco.

While great inroads have been made in preventing and treating the disease since it was first discovered 31 years ago, people are still getting infected, living with it and dying.

Big numbers

As of the end of March, there have been 29,131 cumulative cases of AIDS and another 5,996 cases of HIV non-AIDS recorded in San Francisco, according to city health department data. There have been 19,606 reported deaths in the city from the disease.

An estimated 15,523 people in the city are living with the virus, many of them for years or decades. "One reason for that is because of our system of care," Wiener said. "It's critical we don't let it unravel."

San Francisco currently spends more than $70 million a year on HIV/AIDS-related services, said Greg Wagner, the health department's budget chief.

The city, with an annual budget in the $7 billion range, faces a projected $170 million deficit in the new fiscal year and a $312 million shortfall the year after that. By law, the mayor must submit a balanced budget proposal to the Board of Supervisors for consideration.

"The mayor is very aware of and concerned about Ryan White Care funding cuts, and he is working to protect these programs and services," said Lee's spokeswoman, Christine Falvey. "He... is working to find a solution, but the mayor is also trying to close a $170 million budget shortfall."